03-26-2020, 10:31 AM
seems like an annual vaccine schedule might do the trick?
(03-26-2020, 10:29 AM)martyup Wrote:
(03-26-2020, 09:11 AM)cardcrimson Wrote:
(03-26-2020, 09:00 AM)2006alum Wrote:
(03-26-2020, 10:29 AM)martyup Wrote:
(03-26-2020, 09:11 AM)cardcrimson Wrote:
(03-26-2020, 09:00 AM)2006alum Wrote:
(03-26-2020, 09:00 AM)2006alum Wrote: And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own.Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.
(03-26-2020, 09:00 AM)2006alum Wrote: And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own.Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.
(03-26-2020, 05:43 AM)OutsiderFan Wrote: The United States was probably one of the top 2-3 most prepared countries to deal with a pandemic. There was a 60+ page pandemic response manual prepared for the White House. When the transition from 44 to 45 happened, someone who was since fired or otherwise removed from a position of influence to use it, was really happy to have and appreciated the guidance because he planned to have the new administration use it if ever faced with the need, so he thought.
IOW, the White House had an instruction manual to follow - probably few countries had - but never took it out of the proverbial drawer and totally pissed away the first mover advantage the U.S. had. Who the hell knows why the manual was ignored, but anyone who thinks the White House hasn't failed spectacularly really needs to read this:
https://www.politico.com/news/2020/03/25...cil-149285
No, the virus couldn't have been completely stopped, but had recommendations that were available and produced by people who knew WTF they were doing actually been followed, which includes responding quickly and in a coordinated fashion, we wouldn't be facing the catastraf*ck on the scale we are now.
Highlighting failures and blaming people are two sides of the same coin. This post isn't an effort to blame anyone as much as it is to highlight the value of having the best people in charge, and the importance of holding those who screw up accountable. Because without accountability, there will be nothing but more disaster ahead.
(03-26-2020, 05:43 AM)OutsiderFan Wrote: The United States was probably one of the top 2-3 most prepared countries to deal with a pandemic. There was a 60+ page pandemic response manual prepared for the White House. When the transition from 44 to 45 happened, someone who was since fired or otherwise removed from a position of influence to use it, was really happy to have and appreciated the guidance because he planned to have the new administration use it if ever faced with the need, so he thought.
IOW, the White House had an instruction manual to follow - probably few countries had - but never took it out of the proverbial drawer and totally pissed away the first mover advantage the U.S. had. Who the hell knows why the manual was ignored, but anyone who thinks the White House hasn't failed spectacularly really needs to read this:
https://www.politico.com/news/2020/03/25...cil-149285
No, the virus couldn't have been completely stopped, but had recommendations that were available and produced by people who knew WTF they were doing actually been followed, which includes responding quickly and in a coordinated fashion, we wouldn't be facing the catastraf*ck on the scale we are now.
Highlighting failures and blaming people are two sides of the same coin. This post isn't an effort to blame anyone as much as it is to highlight the value of having the best people in charge, and the importance of holding those who screw up accountable. Because without accountability, there will be nothing but more disaster ahead.
(03-26-2020, 10:50 AM)BostonCard Wrote: While it looks like California and Washington are doing a bit better than average, New York is obviously a nightmare and Louisiana (also with a Democratic governor) looks to be the next hotspot.Please don't jinx CA and WA. =/ I think WA was artificially thrust into the lead due to the outbreak landing spot (nursing home). If you minimize that contribution and adjust the start date, WA is moving up just like any other state. CA...I worry what next week will look like.
Quote:But the bottom line is that while I think we could have been much better prepared, I doubt this could have been prevented entirely. There is just too much global travel and coronavirus spreads much to easily undetected to have truly allowed us to prevent the pandemic entirely.
(03-26-2020, 10:50 AM)BostonCard Wrote: While it looks like California and Washington are doing a bit better than average, New York is obviously a nightmare and Louisiana (also with a Democratic governor) looks to be the next hotspot.Please don't jinx CA and WA. =/ I think WA was artificially thrust into the lead due to the outbreak landing spot (nursing home). If you minimize that contribution and adjust the start date, WA is moving up just like any other state. CA...I worry what next week will look like.
Quote:But the bottom line is that while I think we could have been much better prepared, I doubt this could have been prevented entirely. There is just too much global travel and coronavirus spreads much to easily undetected to have truly allowed us to prevent the pandemic entirely.
(03-26-2020, 11:38 AM)magnus Wrote: .in order to have really shut this down, given the average American's lack of social distance and facemasking, we'd have to have acted from the start as if this virus were contagious pre-symptoms. Which would have required a much higher level of action to counter...a level of action that I can't imagine any American government would be able to justify undergoing without proof.Yes. In the interview linked elsewhere on this board, SSC's Dr. Cody said the key moment was when they had the first patient who had acquired the virus from "community spread" -- i.e., they could not identify how or where she got it from. It probably would have been impossible at that time for her to have imposed the shelter-at-home order that would have been needed to tamp down the spread early in its exponential growth. But it raises the question in my mind, was it necessary for us to see community spread without symptoms here when it was happening outside the U.S.?
(03-26-2020, 11:38 AM)magnus Wrote: .in order to have really shut this down, given the average American's lack of social distance and facemasking, we'd have to have acted from the start as if this virus were contagious pre-symptoms. Which would have required a much higher level of action to counter...a level of action that I can't imagine any American government would be able to justify undergoing without proof.Yes. In the interview linked elsewhere on this board, SSC's Dr. Cody said the key moment was when they had the first patient who had acquired the virus from "community spread" -- i.e., they could not identify how or where she got it from. It probably would have been impossible at that time for her to have imposed the shelter-at-home order that would have been needed to tamp down the spread early in its exponential growth. But it raises the question in my mind, was it necessary for us to see community spread without symptoms here when it was happening outside the U.S.?
(03-26-2020, 10:49 AM)Goose Wrote:(03-26-2020, 09:00 AM)2006alum Wrote: And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own.Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.
The problem may very well be (is, IMHO) that the Santa Clara County Health Department doesn't have the trained staff to do so. If this were a "small" outbreak, the USPHS might have enough trained people they could send to help us do it/do it for us, although even then I think it is a bit "iffy". Given the size of the outbreak, that isn't feasible. We need to slap together enough people to do this, and quickly. The cavalry isn't going to ride in and save us. In this case, it doesn't really exist.
(03-26-2020, 10:49 AM)Goose Wrote:(03-26-2020, 09:00 AM)2006alum Wrote: And it has to be national: even if the Santa Clara Health Commissioner were the world's finest, he or she can't isolate cases coming from outside Santa Clara all on her own.Yes she can (not personally, but with an adequate, trained staff). It is inherently a mostly "local" action anyway. One of the real encouraging aspects of this whole thing is how well the Bay Area counties have worked together to start a community response. This type of tracing activity needs to be "national" only in the sense that people who are determined as likely to be ill have to be traced even if they cross state lines. Theoretically, the USPHS is responsible for making sure this happens. The "within California cases" can be handled within California. It doesn't require (or really benefit from) getting the USPHS directly involved tracing local cases. We do need a national data base of un-located contacts/potentially exposed persons, but not much more. Without this data base, it will be more difficult but not impossible to keep the disease under control. The elimination of outbreak "pockets" will be a continuing requirement in any case.
The problem may very well be (is, IMHO) that the Santa Clara County Health Department doesn't have the trained staff to do so. If this were a "small" outbreak, the USPHS might have enough trained people they could send to help us do it/do it for us, although even then I think it is a bit "iffy". Given the size of the outbreak, that isn't feasible. We need to slap together enough people to do this, and quickly. The cavalry isn't going to ride in and save us. In this case, it doesn't really exist.
(03-26-2020, 01:47 PM)OutsiderFan Wrote: This. Is. Madness. Again, if we can't hold people accountable for their actions when they exercise terrible judgment that put others at risk, why are we even here? We all have a responsibility to each other to hold people accountable when they fail or the fabric of society cannot hold.
(03-26-2020, 01:47 PM)OutsiderFan Wrote: This. Is. Madness. Again, if we can't hold people accountable for their actions when they exercise terrible judgment that put others at risk, why are we even here? We all have a responsibility to each other to hold people accountable when they fail or the fabric of society cannot hold.
(03-26-2020, 12:58 PM)2006alum Wrote: I guess my point was simply that unless every county health commissioner is doing this, if others aren't, and those contagious patients go across county and state lines, it starts all over again. In this sense, the spillovers are unavoidable and the only way to fix it is a consistent, nationwide response.You are correct that a trace and test strategy can be overwhelmed by an influx of infected people from elsewhere. It is necessary that each county at least keep the cases down to a dull roar. If we are all at about the same point when the controls start being lifted, that should be possible. As for a consistent nationwide response, I don't think so. As Dr. Fauci has pointed out, each situation is different. The entire population of Lincoln County Nevada could be positive and move to Santa Clara County tomorrow. That would be problematic but not overwhelming. Lincoln County doesn't need and can't do what Santa Clara and San Mateo can and must do.
Quote:Taiwan wouldn't have simply 1/2 the success it's having if 1/2 the island declined to test, contact trace, and isolate, because it only takes a few rotten/contagious apples to re-spoil the whole barrel.Actually, no. It takes a critical mass of contagious apples to spoil the whole barrel. China is dealing with that situation now. So is Singapore. So far, so good. However, they could end up being overwhelmed if there are too many, just as Santa Clara county could be. It isn't going to be easy to do since we are starting from such a weak initial capability. If we fail at this, we have the possibility of a big rebound, and generating the political will to go back to shelter-in-place will be difficult to impossible. Many will justly ask "It didn't work the first time. Why take the economic hit again if it won't work?".
(03-26-2020, 12:58 PM)2006alum Wrote: I guess my point was simply that unless every county health commissioner is doing this, if others aren't, and those contagious patients go across county and state lines, it starts all over again. In this sense, the spillovers are unavoidable and the only way to fix it is a consistent, nationwide response.You are correct that a trace and test strategy can be overwhelmed by an influx of infected people from elsewhere. It is necessary that each county at least keep the cases down to a dull roar. If we are all at about the same point when the controls start being lifted, that should be possible. As for a consistent nationwide response, I don't think so. As Dr. Fauci has pointed out, each situation is different. The entire population of Lincoln County Nevada could be positive and move to Santa Clara County tomorrow. That would be problematic but not overwhelming. Lincoln County doesn't need and can't do what Santa Clara and San Mateo can and must do.
Quote:Taiwan wouldn't have simply 1/2 the success it's having if 1/2 the island declined to test, contact trace, and isolate, because it only takes a few rotten/contagious apples to re-spoil the whole barrel.Actually, no. It takes a critical mass of contagious apples to spoil the whole barrel. China is dealing with that situation now. So is Singapore. So far, so good. However, they could end up being overwhelmed if there are too many, just as Santa Clara county could be. It isn't going to be easy to do since we are starting from such a weak initial capability. If we fail at this, we have the possibility of a big rebound, and generating the political will to go back to shelter-in-place will be difficult to impossible. Many will justly ask "It didn't work the first time. Why take the economic hit again if it won't work?".
(03-26-2020, 10:03 AM)JustAnotherFan Wrote:Apparently you don't. At least if they don't think like you.(03-26-2020, 07:56 AM)cardcrimson Wrote: So please, stop with the constant automatic criticisms of Trump and the administration. People are dying by the thousands and we as a country need to resolve it. By the way, 60% of Americans approve of Trump's handling of the crisis so far. If the Cardboard were a measure, it be 99% think he should be tried for mass murder.
Do you believe Stanford grads tend to be more thoughtful, more intelligent, more critical, and more ethical than the general public?
(03-26-2020, 10:03 AM)JustAnotherFan Wrote:Apparently you don't. At least if they don't think like you.(03-26-2020, 07:56 AM)cardcrimson Wrote: So please, stop with the constant automatic criticisms of Trump and the administration. People are dying by the thousands and we as a country need to resolve it. By the way, 60% of Americans approve of Trump's handling of the crisis so far. If the Cardboard were a measure, it be 99% think he should be tried for mass murder.
Do you believe Stanford grads tend to be more thoughtful, more intelligent, more critical, and more ethical than the general public?
(03-26-2020, 10:22 AM)2006alum Wrote:(03-26-2020, 10:07 AM)BostonCard Wrote: Immunity to other coronaviruses (the ones that cause a common cold) lasts for about a year, unfortunately. It isn't because the virus mutates, but rather because immunity to different viruses wanes at different rates (for example, immunity to chicken pox lasts a lifetime).
BC
Yikes. BC, if that's so, then does that suggest a vaccine isn't actually a panacea after all, and we will now need to live with annual COVID-19 resurgences the way we live with resurgences of the flu and common colds? Given how much more dire the case outcomes are, that's terrifying if so.
(03-26-2020, 10:22 AM)2006alum Wrote:(03-26-2020, 10:07 AM)BostonCard Wrote: Immunity to other coronaviruses (the ones that cause a common cold) lasts for about a year, unfortunately. It isn't because the virus mutates, but rather because immunity to different viruses wanes at different rates (for example, immunity to chicken pox lasts a lifetime).
BC
Yikes. BC, if that's so, then does that suggest a vaccine isn't actually a panacea after all, and we will now need to live with annual COVID-19 resurgences the way we live with resurgences of the flu and common colds? Given how much more dire the case outcomes are, that's terrifying if so.
(03-26-2020, 04:42 PM)CornFed Wrote:(03-26-2020, 10:03 AM)JustAnotherFan Wrote:Apparently you don't. At least if they don't think like you.(03-26-2020, 07:56 AM)cardcrimson Wrote: So please, stop with the constant automatic criticisms of Trump and the administration. People are dying by the thousands and we as a country need to resolve it. By the way, 60% of Americans approve of Trump's handling of the crisis so far. If the Cardboard were a measure, it be 99% think he should be tried for mass murder.
Do you believe Stanford grads tend to be more thoughtful, more intelligent, more critical, and more ethical than the general public?
(03-26-2020, 04:42 PM)CornFed Wrote:(03-26-2020, 10:03 AM)JustAnotherFan Wrote:Apparently you don't. At least if they don't think like you.(03-26-2020, 07:56 AM)cardcrimson Wrote: So please, stop with the constant automatic criticisms of Trump and the administration. People are dying by the thousands and we as a country need to resolve it. By the way, 60% of Americans approve of Trump's handling of the crisis so far. If the Cardboard were a measure, it be 99% think he should be tried for mass murder.
Do you believe Stanford grads tend to be more thoughtful, more intelligent, more critical, and more ethical than the general public?
(03-26-2020, 05:40 PM)2006alum Wrote:(03-26-2020, 10:22 AM)2006alum Wrote:(03-26-2020, 10:07 AM)BostonCard Wrote: Immunity to other coronaviruses (the ones that cause a common cold) lasts for about a year, unfortunately. It isn't because the virus mutates, but rather because immunity to different viruses wanes at different rates (for example, immunity to chicken pox lasts a lifetime).
BC
Yikes. BC, if that's so, then does that suggest a vaccine isn't actually a panacea after all, and we will now need to live with annual COVID-19 resurgences the way we live with resurgences of the flu and common colds? Given how much more dire the case outcomes are, that's terrifying if so.
Maybe I missed the response to this in all the cross-chatter, but I'm still wondering why we think a vaccine is a panacea if it turns out our immunity could wane relatively rapidly. Stories like this one are beginning to concern me:
[tweet]https://twitter.com/Laurie_Garrett/status/1243328270059405312?s=20[/tweet]
Although this is being freshly reported, I think that story is based off of a study released a few weeks ago. But it raises the same concern - if the immunity is temporary, would that mean we'd need to get re-immunized as often as annually? I'd welcome any input from experts in medicine or immunology on this, because it seems like we've all been operating under the assumption that social distancing and testing, contact tracing, and isolation are stopgaps to getting a "cure" in the form of immunization.
(03-26-2020, 05:40 PM)2006alum Wrote:(03-26-2020, 10:22 AM)2006alum Wrote:(03-26-2020, 10:07 AM)BostonCard Wrote: Immunity to other coronaviruses (the ones that cause a common cold) lasts for about a year, unfortunately. It isn't because the virus mutates, but rather because immunity to different viruses wanes at different rates (for example, immunity to chicken pox lasts a lifetime).
BC
Yikes. BC, if that's so, then does that suggest a vaccine isn't actually a panacea after all, and we will now need to live with annual COVID-19 resurgences the way we live with resurgences of the flu and common colds? Given how much more dire the case outcomes are, that's terrifying if so.
Maybe I missed the response to this in all the cross-chatter, but I'm still wondering why we think a vaccine is a panacea if it turns out our immunity could wane relatively rapidly. Stories like this one are beginning to concern me:
[tweet]https://twitter.com/Laurie_Garrett/status/1243328270059405312?s=20[/tweet]
Although this is being freshly reported, I think that story is based off of a study released a few weeks ago. But it raises the same concern - if the immunity is temporary, would that mean we'd need to get re-immunized as often as annually? I'd welcome any input from experts in medicine or immunology on this, because it seems like we've all been operating under the assumption that social distancing and testing, contact tracing, and isolation are stopgaps to getting a "cure" in the form of immunization.